As Covid surges, health officials must remember that in-person postpartum care is essential

As the omicron variant again forces hospitals to make difficult decisions about the care to be provided, Covid-19 must not delay postpartum care again. Postnatal care is an essential health care and we should expand access rather than restrict it. This is illustrated by the experiences of women who gave birth in the early days of the pandemic.

I gave birth to my youngest daughter in March 2020 just as our state was shutting down. Things changed quickly when I attended my final prenatal care appointments and walked into the hospital to deliver her. New restrictions meant I had to attend prenatal appointments without my partner, and I was limited to a single attendant when it came time to give birth.

The outbreak of the pandemic disrupted any progress towards this new paradigm for postpartum care in the US by undermining access to a single postpartum exam at six weeks.

We were discharged early just 24 hours after Lily was born to limit our risk of contracting Covid in hospital. Despite the extraordinary adjustment this unprecedented crisis has demanded of our healthcare system, I have consistently felt that my healthcare providers and the healthcare system at large have a commitment to care for my baby and I.

That changed when I left the hospital. I had never felt so alone. Even in normal times, weekly visits in late pregnancy are giving way to a deep lack of attention for women in the US after childbirth. A single routine postpartum visit at six weeks otherwise leaves women largely on their own to manage physical and emotional challenges that vary in severity, from postpartum pain to depression to difficulty breastfeeding.

As a researcher studying the transition to parenthood, I have always wished that mothers in the United States had the same access to greater support and aftercare that women in other high-income countries routinely receive. Instead, with the onset of the pandemic, access to even a single postpartum visit has been restricted and pre-existing inequalities in postpartum care based on racial/ethnic, geographic and income boundaries have been exacerbated. Endemic racism, rural shortages and lack of insurance are just some of the factors contributing to the reduced access to healthcare that the pandemic has exacerbated.

My six-week postpartum visit was conducted via telemedicine. It only lasted a few minutes. Instead of being evaluated and treated by a clinician, I was asked to self-diagnose. Questions like, “Do you think the tear you sustained during childbirth is healing well?” felt impossible to answer. “I think so?” I replied, unsure and desperately wanting a professional opinion.

I also struggled emotionally with the compound effects of sleep deprivation, early parenthood, and the loss and uncertainty brought on by the pandemic. But the message I received was very clear: we really don’t want to call you in, and you should only ask to visit if your need is really urgent. I didn’t feel able to make that call. I certainly didn’t know how to balance the risk of long-term consequences of not healing properly against the risk of catching Covid during the visit and bringing it home to my family.

Over the past year, I’ve surveyed dozens of mothers like me who gave birth early in the pandemic about their experiences. From my interviews, I know that mothers in the US faced similar barriers when it came to accessing personal postpartum care, and for some the cost was significant.

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One new mom who said she suffered from postpartum depression told me, “It took me a long time to feel like I could commit to an in-person appointment. And then when I felt like tires were being thrown at me over and over again, it was incredibly discouraging and emotional and really hard on my own mental health.”

Another mother says she experienced a rare complication from an epidural injection. She said her health care providers downplayed her pain and discouraged her from seeking in-person care, delaying identification and treatment of nerve damage. She told me, “It was very frustrating… in the meantime it went from numbness to extreme pain… and I’m still dealing with it.” [a year later].”

Our experiences were collateral damage stemming from guidelines released by the Centers for Medicare and Medicaid Services in mid-March 2020. The guidelines recommended postponing non-essential medical services to conserve resources for the Covid response, but did not define “essential”. Many healthcare systems chose to delay postpartum follow-up or switch postpartum appointments to telemedicine.

The American College of Obstetrics and Gynecologists recognizes the weeks after birth as a critical time in maternal and fetal health, setting the stage for long-term health and well-being. The organization recommends that postnatal care should be an ongoing process, not a one-off encounter. In 2018, its Committee on Obstetrics, along with its Presidential Task Force on Redefining the Postpartum Visit, announced that all women should make contact with their healthcare provider within the first three weeks after delivery, followed by one based on each woman’s needs tailored ongoing care .

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Unfortunately, the outbreak of the pandemic has disrupted any progress toward this new paradigm for postpartum care in the US, by undermining access to even a single postpartum exam at six weeks.

We are now at another tipping point as the omicron variant contributes to a record number of cases. Again, healthcare systems need to determine which services need to be delayed to weather the current wave of the pandemic. This is of course not an easy task. But the experiences of mothers who gave birth early in the pandemic, and the recommendations of the nation’s leading professional membership organization dedicated to women’s health, make it clear that postpartum care is essential health care and must not be postponed again.

source https://www.bisayanews.com/2022/01/23/as-covid-surges-health-officials-must-remember-that-in-person-postpartum-care-is-essential/